Corn (medicine)

Heloma

(Corn or Clavus)

Definition. A heavy thickening of the cuticle, usually caused by pressure, and producing pain by its own pressure on the tissues beneath.

Though the term heloma is rarely used outside of text books, there are very few who have not had an unpleasant acquaintance with this cutaneous affection, under the name of “corns.” Heloma is undoubtedly the most frequent of all skin diseases.

Cause. The exciting cause of helomata is intermittent pressure combined with friction; while among the predisposing causes it is only necessary to mention the slavish adherence to fashion which lends all of us to wear stiff leather shoes, the contour of which bears little or no relation to the natural shape of the anterior portion of the foot. The pressure of the ill-fitting boot upon the toes, or, more strictly speaking, the pressure of the toes against the unyielding leather, in walking, soon occasions hypertrophy of the horny layer at the point of irritation, and in time a dense, conical, pea-sized or larger mass is formed. The apex of the cone presses downward on the sensitive papillae and causes the painful sensation which suggests a visit to the chiropodist.

Helomata are named according to characteristics which mark them. When the growth is indurated it is called heloma durum; when soft, heloma molle; when of the millet seed variety, heloma miliare; when blood vessels are numerous, heloma vasculare. Each of these varieties requires a different method of treatment.

Helomata are most frequently found on the outer surface of the little toes, but may occur upon the sole of the foot and even upon the palm, or plantar surface of the foot. Between the toes they often form from pressure of the opposing digits, caused by narrow shoes, and in this location they are softer and usually present a whitish, macerated surface.

The Prophylatic Treatment  consists in wearing a broad-toed, though not necessarily a square-toed shoe.

If shoes were made fan-shaped, like the imprint of a bare-foot in the sand, instead of having the greatest width across the ball of the foot, they might look strange at first, but they would be comfortable for all time. Those then who care more for comfort than for style, as most of us falsely profess to do, would have both cornless and comely feet.

The Palliative Treatment  of helomata consists of first softening the dense, hard, horny tissue, when it will exfoliate spontaneously, or be readily scraped away. This projecting callous portion of the heloma may be removed by cutting or scraping till, as nearly as may be, the surface is level with the plane of the adjacent skin.

In the soft variety found between the toes, or in the vascular ones, located in the arch on the inner border of the foot, where the skin is thin, no thick covering will be encountered.

A line or groove will be observed marking the circumference of any variety of heloma, and it is in this line that the operative attack must be made.

Helomata of the miliary variety, usually appear on the sole of the foot and are, as a rule, as numerous as they are small. The preferable treatment is to use a sharp, pointed knife in removing each one of the “seeds” separately.

A well pointed, narrow blade introduced here will find a plane of cleavage between the growth and the surrounding tissue, through which it is possible to dissect quite deeply without encountering blood. When the dissection reaches the papillary layer in the skin, as evidenced by the red color, further operative steps should cease.

In the treatment of soft and vascular growths it may frequently be preferable to employ disintegrating solutions from the beginning.

Repetition of the treatment, as described in verruca, every second or third day, will result in the gradual disintegration of the growth to its extreme depth, and prove more satisfactory than the radical operation.

Healing is rapid and with the use of properly shaped, and roomy foot-gear, recurrence should not take place.

It is evident from the nature of helomata, that any “cure,” rubbed or painted upon the affected surface, can only cause the softening of a certain thickness of skin, and that no hope for cure is justified unless the careful and complete removal of the growth is accomplished and followed by the use of roomy foot-gear.

Radical Cure. The total excision of corns, while disabling the patient more or less for a few days, is in many instances justifiable. There is little probability of recurrence if proper foot-gear is worn, and the results are especially good if the skin graft operation as devised by Dr. Robert T. Morris is employed, which is described in the next paragraph.

After the excision of the growth, a small piece of skin is removed from the leg and sewn to the denuded area. This prevents a tough cicatrix forming and assures a normal skin covering to the area previously occupied by the corn.

The Text Book of Practical Chiropody, now in course of preparation, will contain lengthy and explicit articles on the subjects of verruca and heloma. The purpose here has been largely to present the subject from a broad surgical viewpoint. The strictly chiropodial features will be thoroughly outline in the Text Book of Practical Chiropody after a manner never before attempted and will include all details of the chisel methods, the dissecting methods and the shaving operations.